Dr. D. J. W. Strümpfer

Historical Background
Aaron Antonovsky (see the September 2005 Faculty Corner, was professor of medical sociology at the Ben Gurion University in Israel. He studied questions around how people manage stress and stay well. He coined the term salutogenesis, referring to the origins of health (L: salus = health, G: genesis = origins).

Origins of Fortigenesis
In 1995, on the back of his construct, I coined the term fortigenesis (L: fortis = strong), referring to strength shown at other endpoints (e.g., in work, marriage, parenthood, developmental transitions). My argument was that using health figuratively to describe the well-being of a family or a business organization, for instance, overstretches its meaning.

However, Antonovsky was a humble man who, while outspoken, was afraid of being megalomaniac. He did not want to explain everything, preferring to stay within his own field. His own writings were fully compatible with the idea of emphasizing strength.

The Health-Ease and Dis-Ease Continuum
In connection with health, he posited a continuum of health-ease/dis-ease, along which individuals can be placed, but along which they also move from one side to the other in terms of changing levels of well being. In this connection, there are other ease/disease continua, too (e.g., family relations, social relations, material resources).

Introduction of Fortigenesis
Two South African colleagues, Marié Wissing and Chrizanne van Eeden (2002), went further with fortigenesis, by introducing the concept of psychofortology (or fortology to be more general) to describe a subdiscipline in which the origin of psychological well-being is studied. I prefer the term fortology to the currently popular positive psychology, since it does not contain an exclusive emphasis on psychology. In fact, the same general orientation can be traced in social work, nursing, dietary science, biokinetics, organizational behavior, and even economics and architecture.

Defining Sense of Coherence
Antonovsky’s core explanatory construct was the sense of coherence (SOC), to describe a cognitive and emotional appraisal style, associated with effective coping, health-enhancing behavior, and better social adjustment. It mitigates life stress by affecting the overall quality of one's perception of the stimuli that impact one.

A strong SOC contains three components: (a) Comprehensibility exists when influences from the environment are perceived as making cognitive sense; (b) manageability occurs when these influences are perceived as under the control of, firstly, the individual and, secondly, legitimate others, such as a spouse, friends, professionals, formal authorities, or spiritual figures; lastly, (c) meaningfulness is experienced when messages from the environment are perceived as motivationally relevant, in the form of welcome challenges in which one deems it to be worth engaging and investing oneself.

SOC Prediction Capacity
Fifteen years later, in addition to a significant number of health studies on sense of coherence, there is also a range of studies (several from Finland) that have shown that Antonovsky's SOC questionnaire predicts work criteria. For instance, by means of the SOC questionnaire, colleagues and I could differentiate two groups of people who worked in hazardous occupations from regular members of the same organizations:

1. Members of mine rescue teams who, in addition to being experienced mine workers, had been selected and trained for their highly specialized tasks and were also experienced at these. It was argued that a strong SOC would be a valuable component of their makeup. They were compared with regular mine workers, matched on some control variables.
   
   
2. The second group consisted of members of the Special Task Force of the national police force, again specifically selected, highly trained, and highly experienced in all manner of hazardous assignments. They were compared to regular police officers.

In both instances, the SOC questionnaire could place the two groups in their particular samples with highly significant accuracy.

Of course, related concepts have been proposed and studied, each with its own measure. (Psychologists are very fond of self-report questionnaires.) One of the first was Kobasa's (1982) well-known hardy personality. Another model is Ryan and Deci's (2000) self-determination theory, positing three innate, essential, and universal psychological needs: (a) relatedness, (b) competence, and (c) autonomy. These needs must be satisfied across the life span for an individual to experience psychological growth, integrity, well-being, vitality, and self-congruence.

An even more complex conceptualization is that of Ryff (1995), who integrated elements from relevant theories to develop a model of subjective well-being. Her concerns are with the nature of optimal human development and positive functioning. The model contains six components: (a) self-acceptance, (b) positive relations with other people, (c) autonomy, (d) environmental mastery, (e) purpose in life, and (f) personal growth.

Critique of the Models
The above models all assume a single continuum of psychological health/strength. More recently, questions arose about the possibility of two continua, one representing psychological ill heath and the other psychological wellness. In the area of mental illness, a range of measuring instruments and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association allowed empirical anchoring and structure. The same is only beginning to occur on the psychological health side, in the form of the Values in Action Classification (Peterson & Seligman, 2004). However, it runs the danger of encapsulating moral/ethical/religious views of the best ways to live, but not enough psychological insight.

Mental Health Continuum
Keyes (2002, 2005) provided an alternative—proposing a mental health continuum, as part of his conception of complete mental health. He (2002) visualized it as a bipolar continuum, from flourishing to languishing, next to a mental illness continuum. When people are flourishing, they experience high levels of positive emotion, and they function well both psychologically and socially. Languishing, on the other hand, is experienced as emptiness and stagnation, leading to a life of quiet despair. Persons in this condition are likely to describe their lives in terms such as hollow, empty, and a void.

Keyes (2005) operationalized his continuum of mental health by means of questions on positive affect, Ryff's (1995) measures of psychological well-being (referred to above), and his own measures of social well-being (1998). He construed mental illness in terms of psychiatric morbidity and operationalized it by means of a structured interview based on the DSM. Confirmatory factor analyses indicated that mental health and mental illness constituted two distinct, but significantly negatively correlated axes. In his conceptualization, complete mental health consists of the absence of mental illness and the presence of flourishing.

Unstable Variables
Neither mental/psychological illness nor mental/psychological health is a stable, permanent condition—people are likely to move higher and lower along these continua in consequence of both subjective and external conditions. In Keyes' terms, they could theoretically move from a pure form of a mental illness down to an absence of such illness. Along the other continuum, they could theoretically move from pure languishing up to pure flourishing.

A large variety of personal experiences could be behind the moving upwards or downwards along the languishing-flourishing continuum. For instance, waxing fortigenic processes could include a rejuvenating love relationship, joyful parenthood, continuing education, self-directed work experiences, participation in socially valued decision-making, small-group experiences, and psychotherapy. Religious conversion and participation, or experiences that increase a person's spirituality, could also contribute.

An endless range of untoward experiences could result in downward movement, when fortigenic processes wane. Loss of a loved one, disease, injury, disablement, untoward work experiences from which there is no escape, unemployment, discrimination, persecution, imprisonment, political repression, war—these are all external circumstances that could affect psychological functioning disastrously. Such processes are not necessarily irreversible, however; eventually a person could start climbing upwards again.

Examining the Languishing-Flourishing Continuum
Keyes (2005) reported data from the Midlife in the United States Survey (MacArthur Foundation Research Network on Successful Midlife Development). He found a more or less normal distribution on the languishing-flourishing continuum: Almost as many adults were languishing (about 17%) as were flourishing (about 18%), with most adults (about 60%) being moderately mentally healthy. Individuals who were less than flourishing showed higher levels of dysfunction in terms of psychosocial functioning, health limitations, and work reduction.

Fortigenesis
Fortigenesis is not about just positive, joyful growth experiences. It also consistently pays attention to fearful, painful, hurtful, and desperate circumstances endured. Suffering is inherent to the human condition. However, too much of traditional psychology stood still at this point. It should be acknowledged equally that sources of strength exist, through which these demands can be endured and overcome, even to the point of harnessing them towards personal growth and toughness. Eventually, these strengths could lead to flourishing. However, purely positive experiences, which bring joy, provide meaning, and stimulate growth, lead to the heights of flourishing. 

References

Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass.

Keyes, C. L. M. (1998). Social well-being. Social Psychology Quarterly, 61, 121–140.

Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Research, 43, 207–222.

Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548.

Kobasa, S. C. (1982). The hardy personality: Toward a social psychology of stress and health. In G. S. Sanders & J. Suls (Eds.), Social psychology of health and illness (pp. 3–22). Hillsdale, NJ: Erlbaum.

Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. New York: Oxford University Press.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68–78.

Ryff, C. D. (1995). Psychological well-being in adult life. Current Directions in Psychological Science, 4, 99–104.

Strümpfer, D. J. W. (1995). The origins of health and strength: From "salutogenesis" to "fortigenesis." South African Journal of Psychology, 25, 81–89.

Wissing, M. P., & van Eeden, C. (2002). Empirical clarification of the nature of psychological well-being. South African Journal of Psychology, 32, 32–44.